What Happens in a First Coaching Session
The Mental Model You Walk In With Is Probably Wrong
Most physicians considering their first coaching session have already built a picture of what it will be like. That picture is almost always wrong. You are imagining something pulled from experiences you already have — a therapy intake, a faculty performance review, a meeting with a mentor who talks more than they listen. A first coaching session for a physician is none of those things. The gap between what you expect and what actually happens is where the value starts.
It Is Not Therapy
This is the comparison I hear most often. Physicians assume that sitting across from someone and talking about what is hard must be therapy by another name.
It is not. Therapy works backward — examining past experiences and psychological conditions that affect your present. Coaching works forward. We focus on where you want to go professionally and what keeps getting in the way. Lois Zachary, author of The Mentor's Guide, draws a useful distinction between relationships that heal and relationships that develop. Therapy heals. Coaching develops.
If you sit down for your first coaching session expecting to process grief or unpack anxiety, a responsible coach will notice and point you toward the right kind of help. That is not a rejection. That is the system working.
It Is Not a Performance Review
This is the second most common fear. Somewhere in the back of your mind, you are bracing for evaluation. You expect someone to assess your leadership skills, find your deficiencies, and hand you a development plan written in someone else's priorities.
That is not what happens. There is no rubric. No rating scale. No one is reporting back to your department chair. The session is entirely confidential, and the agenda is yours.
I will ask you questions. Some will be direct. But the purpose of every question is to help you think more clearly — not to catch you off guard. You are not being tested. You are being heard.
It Is Not Advice-Giving
A mentor tells you what they did and what they think you should do. A consultant hands you a framework. A coach does something different. A coach asks you what you think and then stays quiet long enough for you to actually figure it out.
Research by Erik de Haan and colleagues, published in Consulting Psychology Journal, found that the working alliance between coach and client — not the coach's expertise — is the strongest predictor of coaching outcomes.
What to Expect Coaching to Feel Like
So if it is not therapy, not a review, and not advice — what is it?
It is a focused conversation. Here is roughly what happens.
- You talk about what is going on. Not a rehearsed summary. The real version. Whatever is taking up space in your head — a leadership decision, a career crossroads, a colleague situation that has gone sideways.
- I listen and ask questions. Carefully. The kind that make you stop and say, "I have not thought about it that way."
- We identify what matters most. Out of everything you bring, there are usually one or two threads that carry real weight. We find those.
- You leave with something to think about. Not a homework assignment. A question, an observation, a small experiment to try before we talk again.
The whole thing takes forty-five to sixty minutes. You will talk more than I do. That is by design.
The Part That Surprises People
Physicians are used to being the smartest person in the room. That is not a criticism — it is a job requirement. But it means you are rarely in a setting where someone asks you a question and then waits, without judgment, for the honest answer.
That is what a first coaching session does. It creates space you did not know you needed. Think of it like a quarterback watching game film with a coaching staff. The coaches are not playing the game for you. They are slowing things down so you can see what you could not see at full speed. The insight is yours. The coach just creates the conditions for it.
You Do Not Need to Be Ready
You do not need to arrive with a polished agenda or a clear sense of your goals. Some of the best first sessions I have had started with a physician saying, "I do not really know what I need. I just know something has to change."
That is enough. The first coaching session is not the place where you prove you have your life figured out. It is the place where you stop pretending you have to.
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